=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649816174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELANO MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2019
-----------------------------------------------------
Last Update Date | 11/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 JEFFERSON ST
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93215-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-725-7793
-----------------------------------------------------
Fax | 661-720-0693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1230 JEFFERSON ST
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93215-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-725-7793
-----------------------------------------------------
Fax | 661-720-0693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RADHEY SHAIM BANSAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 661-330-3726
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------